CommercialCoverageHigh impact
Spinal Cord Stimulation / Dorsal Column Stimulation 7.01.51
Excellus BlueCross BlueShield·Pain Management, Neurosurgery, Orthopedics +1 more·Bone & Joints (Orthopedic)
Effective date
Oct 15, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their spinal cord stimulation policy effective October 15, 2025, establishing specific medical appropriateness criteria for various conditions including failed back surgery syndrome, CRPS, critical limb ischemia, and chronic stable angina. The policy requires behavioral health assessments and specific success thresholds for permanent implantation.
Action Required
By October 15, 2025: Update prior authorization processes to ensure all spinal cord stimulator requests include required documentation: 6+ months of failed conservative treatment, behavioral health attestation showing no contraindications, and for permanent implants, proof of 50% pain reduction during trial. Train providers on specific diagnostic criteria for each covered condition (FBSS, CRPS/RSD, CLI, chronic stable angina). Update encounter forms to capture required clinical elements.